Monoclonal gammopathy of renal significance – diagnostic and therapeutic problems

The term monoclonal gammopathy of renal significance MGRS means a group of renal diseases resulting from the presence of the monoclonal protein produced by plasmatic cells or other clones of B cells. The patients with MGRS do not fulfill the diagnostics criteria both of multiple myeloma and other neoplasm originating from B cells. The involvement of different renal structures in the course of MGRS results the dysfunction of kidneys. The monoclonal protein may injure the glomerular structures (including vascular) as well as tubular structures (interstitial in more wide sense). The early diagnosis of MGRS is difficult and the late detection of the disease is connected with high risk of irreversible renal damage. Therefore, the multidisciplinary cooperation – including general practitioners, nephrologists, hematologists and nephro-pathologists – is particularly important for the diagnostics and treatment of MGRS cases. This new hemato-nephrological meta-disease entity is connected with relatively high morbidity and mortality as well as relapses in transplanted kidney. The decision of the treatment initiation against the toxic clone in MGRS cases results mainly from the nephrological reasons. The article presents current diagnostic and therapeutic possibilities that may be used in MGRS patients. The main purpose of this article was to present the current state of knowledge regarding the diagnostics and treatment of MGRS.